VOICES OF EXPERIENCE Seven Outreach Strategies for Disseminating Information

VOICES OF EXPERIENCE
Seven Outreach Strategies for
Disseminating Prostate Cancer Information
to African American Men
OVERVIEW
This report shares key strategies
related to reaching African-American men and assisting them in
engaging in informed decisionmaking related to prostate cancer
screening. These strategies come
from a series of discussion forums
in Marion and Lake counties in
which a wide array of public health
professionals, communit y members, educators, and faith-based
leaders in the African-American
community shared both personal
and professional experiences.
The experiences and useful ideas
derived from discussion forum participants described in the following
pages center around the following
seven strategies that can be applied
to public health outreach efforts to
better inform African-American
men age 40-65 about prostate cancer:
• Develop Relationships Through
Multidimensional Approaches
• Make it Personal…so it Becomes
Relevant
• Go Where They Are
• Give Them the Truth, Make it
Simple, and Don’t Overwhelm
• Get Their Attention with Relevant
Themes and Incentives
• Enlist Community Spokespeople,
Survivors, and Family Members
to Lend Influence
• Measure Success Over Time
INTRODUCTION
Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death
among Indiana men. African-American men in Indiana die of prostate
cancer more often than any other
racial or ethnic group. The Prostate
Specific Antigen (PSA) screening
test can detect early-stage prostate
cancer, although it is unclear whether
early detection improves health outcomes. For that reason, the Centers
for Disease Control and Prevention
(CDC), along with a number of
national medical organizations, recommend informed decision-making
as opposed to mass screening for all
men.
The CDC states that informed decision-making occurs when an individual understands the nature and risks
of prostate cancer; the risks, benefits,
and alternatives to screening; and
makes a decision consistent with his
preferences and values, or defers the
decision to a later time. All major
medical organizations promote
informed decision-making, as studies have shown that African-American men have poor awareness and
knowledge about prostate cancer. As
such, a number of public health
efforts have been undertaken to better inform African-American men in
Indiana about prostate cancer.
The purpose of this report is to share
key strategies related to reaching
African-American men and disseminating information that will assist
them in engaging in informed decision-making related to prostate cancer screening. The Indiana State
Department of Health contracted
with the Center for Evaluation and
Education Policy at Indiana University to facilitate four discussion
forums (two in Marion County and
two in Lake County in May 2005).
The purpose of the discussion forums
was to gather information on effective strategies for reaching AfricanAmerican men age 40-65 with information about prostate cancer. Across
all of the forums, a wide array of
public health professionals, community members, educators, and faithbased leaders in the African-American community participated in the
discussions and shared both personal
and professional experiences. Their
valuable experience and useful ideas,
summarized in the following pages,
centers around seven main strategies
that can be applied to public health
outreach efforts to better inform
African-American men age 40-65
about prostate cancer.
Strategy #1:
Develop Relationships through
Multidimensional Approaches
“The approach must be multi-programmatic…you've got to reach some people
in the morning, some people in the afternoon, some people in the evening…some
people on weekends, some people
through the week…you need to have a
multi-media campaign, a grassroots campaign, a word-of-mouth campaign…You
don't pick one time or one day or one
approach…there is no one right way…”
One of the strongest messages participants expressed was the necessity for
programmatic efforts to be multidimensional, multifaceted, and built on developing relationships within the
community. Participants raised concerns
that programmatic outreach efforts targeting African-American males often
tend to be exclusively focused on a certain economic class of men, particularly
the middle class. Media strategies such
as television or radio advertising encouraging men to go see their primary care
physician, or access services far away
from their homes or work, can be somewhat effective, but not for the comprehensive economic spectrum of AfricanAmerican men. Participants explained
that outreach strategies limited to a single day, time, or setting would only reach
men for whom that day, time, or setting
was appealing. Participants agreed that
some dates, times, and settings would
likely reach more men than others, but
relying on a single approach would only
reach a certain demographic group of
African-American men. Using a variety
of locations (see Strategy #3), and marketing approaches (see Table 1), will
increase the likelihood of reaching a
larger cross-section of men.
There were many strong suggestions that
a “one-time only” approach will be both
ineffective and harmful in developing
the long-term relationships within targeted populations that are essential to a
successful outreach program (see Strategy #7). Participants said that too often
in their community, many programmatic
efforts were from “outsiders” who, after
their event or program, were never seen
again in the community. Participants
noted that repeated contacts were the
most successful way to build relationships. Utilizing the expertise, credibility,
and locations of existing organizations
and stable services indigenous to the
local community may be the most effective tool in enhancing programmatic success. This provides excellent
opportunities for regional and/or statewide organizations (that may have the
greater resources needed for multidimensional approaches) to partner with
local organizations (that may have
greater potential to build specific relationships within the community).
Table 1. Marketing Suggestions by
Participants
• Networking (word of mouth)
• Billboards
• Fliers
• Worksites during shift changes
• Church bulletins
• PSAs on public television and
radio
• Press releases
• Special interest stories in local
newspapers
Strategy #2:
Make it Personal…so it
Becomes Relevant
“Imagine a commercial or a poster
board…with a grandson on there saying,
'My grandfather can come to my kindergarten graduation because he had his
prostate checked.’ ”
“To pass [his] values of masculinity, sincerity, faithfulness, and higher education to
[his] grandchild resonates further for
grandpa to be aware of where he stands
in relation to his health…”
Participants consistently described African-American men as unlikely to access
VOICES OF EXPERIENCE — 2
healthcare for preventive services, primarily due to a set of priorities that elevate
taking care of one’s family over going to
the doctor. Participants said that when
men seek care, it tends to not be preventive in nature, but rather when there are
signs that “something is wrong” or they
are already feeling sick. Explanations for
why this occurs varied, but the most consistent reason given was that accessing
preventive health services fell low on
their list of priorities. Specifically, going
to the doctor is a low priority for men
when they are not experiencing any
symptoms. In contrast, staying at work
for another hour to provide support for
one’s family is a much higher priority.
Although there are certainly additional
barriers that deter African-American
men from seeking preventive health services, the high priority these men place
on providing support for their family is a
relevant theme that could encourage
their use of preventive health services,
according to discussion forum participants. Specifically, communications
related to the importance of longevity,
taking care of one’s family, and seeing
one’s grandchildren grow up were cited
as messages that would resonate with
African-American men and encourage
them to seek information and utilize preventive health services. Because African-American men age 40-65 place a
high value on taking care of their family,
messages related to “being there” for
their family by taking care of their health
were described as potentially powerful
(see Table 2).
A second theme related to personal motivators that could encourage information
gathering and preventive health practices
involved first-hand knowledge of family
or community members who had prostate cancer. Discussion forum participants consistently shared that knowing
someone with prostate cancer (especially
a family member) served as a catalyst for
them to seek out additional information
and/or get screened for the disease.
Moreover, because families often have a
“veil of secrecy” around health issues
such as cancer, many men are not aware
the disease has already affected their relatives and they may be at increased risk.
When men find out that family members
or people in their community have had
direct experience with prostate cancer,
the possibility of the disease affecting
them becomes much more real.
to provide information at non-traditional
locations where African-American men
with lower incomes spend time. The
township trustee’s office, local banks,
affordable car dealerships, homeless
shelters, and temporary employment
agencies were among the suggested
locales (see Table 3).
Table 2. Approaches to Encourage Informed Decision-Making
• Have survivors tell their story
• Encourage learning about family health history
• Discuss:
o Longevity
o Taking care of one’s family
o Seeing one’s grandchildren grow up
Strategy #3:
Go Where They Are
“We've got to think differently…instead of
having them come to us, we need to go to
them…especially in non-traditional locations…”
Participants said programs designed to
bring African-American men to a central
community location can be successful in
providing education on prostate cancer:
the recent large numbers of AfricanAmerican men being screened at the
Indianapolis Black Expo and other
health fairs were cited as cases in point.
Yet, participants also mentioned that
educational programs offered at locations which many African-American
men already frequent may be more effective than centrally located events. Disseminating information and providing
services at African-American barbershops, churches, alumni fraternities and
sororities, men’s conferences, and sporting events are some examples provided
by participants.
Similar to advice offered about being
intentionally inclusive of African-American men of differing economic status,
participants mentioned that providing
informational services in the aforementioned locations may not be sufficient to
reach African-American men of differing economic levels. It is also necessary
Strategy #4:
Give Them the Truth, Make it
Simple, and Don’t Overwhelm
“You talk about the stigma, you talk about
the approach to this thing. There's too
much information. This is how you take
the prostate out. It leaves you impotent,
does it? You know I worked in urology 13
years ago and that's not how it works anymore. There's a lot of scientific procedures … to prevent men from losing their
manhood. Stigma. Again, this is what
needs to be addressed up front. Good
information.”
Table 3. Recommended Locations
for Reaching a Diversity of AfricanAmerican Men
•
•
•
•
•
•
•
•
•
•
•
Barbershops
Churches
Men's conferences
Sporting events
Trustee's office
Temporary employment agencies
Homeless shelters
Car dealerships
Local Banks
Male Organizations (100 Black
Men, Prince Hall Masons, Indiana Commission on the Social
Status of Black Men)
Worksites
VOICES OF EXPERIENCE — 3
“ We're talking about three different
issues…We're going from basic information about the disease, to information
about you have the disease, to information about treatment. You see what I
mean? That's three different topics all in
one subject.”
Participants consistently said that efforts
to provide prostate cancer information to
African-American men should include
specific action-related resources
designed to provide them with information throughout the entire process, at the
appropriate times. Initially men need to
know basic information about prostate
cancer in order to make informed decisions, in addition to where they can go
for screening (if that is their informed
decision), how much it will cost, and
what will then happen if the test is positive. This information should be presented in a clear and concise format.
Therefore, while certain details and
action-related information can serve to
reduce uncertainties that serve as barriers to preventive healthcare for men, too
much information can be overwhelming
and increase feelings of uncertainty
about seeing a doctor for preventive
healthcare. Table 4 provides a list of
complete and concise information recommended by the CDC for dissemination to African-American males.
Participants also said that information
dissemination and service delivery must
be done in a culturally competent manner. Participants said that while it may be
preferable to have service delivery done
by competent African-American males,
the likelihood of this occurring was rare
given the demographic make-up of
healthcare providers. Therefore, the
training of healthcare providers to ensure
that information dissemination strategies
are done in a culturally appropriate manner will aid in the success of any outreach effort.
Table 4. Recommended Information Topics Related to Prostate Cancer
•
•
•
•
•
•
•
What is the prostate? Prostate cancer? Causes of prostate cancer?
What is Benign Prostatic Hypertrophy (BPH)
What is an African-American’s risk for prostate cancer?
What are the symptoms of prostate cancer?
How do you screen for prostate cancer?
What do medical experts say about screening?
What are the benefits and risks of prostate cancer screening?
Complete information can be found at:
www.cdc.gov/cancer/prostate/prospdf/aaprosguide.pdf
Strategy #5:
Get Their Attention with
Relevant Themes and
Incentives
“You know when you take care of your
car… You make sure it's looking good and
you also take care of the tires, you get the
tune-ups, you do all these things taking
care of that car. You know you should be
taking care of yourself as well. Making
sure you're getting your tune-up or you're
getting your regular checkup. You need to
take care of yourself.”
In all of the forums, participants discussed specific themes (see Table 5) and
incentives to attract African-American
men to outreach events. Perhaps the most
commonly mentioned theme involved
drawing parallels between maintenance
for an automobile and maintenance for a
man’s health. Encouraging men to take
care of themselves like they take care of
their car, through regular “maintenance
checks,” was an idea that garnered widespread support among discussion forum
participants. Other themes suggested by
participants related to sports (often specific sports such as baseball) and “looking good, feeling good” events that
involved a range of activities related to
external appearance (e.g., free haircuts)
and internal health (e.g., blood pressure
screenings). Participants also noted that
African-American men would be more
likely to attend events that involved
“one-stop shopping” (where a number of
multidimensional activities were included
in the same event) as opposed to events
that were more singularly focused on
“health-related issues.”
Participants also noted African-American men are more likely to attend educat i o n a l a n d o u t r e a c h e v e n t s wh e n
desirable incentives are involved. For
example, a free car wash could serve as a
powerful incentive to get men to attend
an educational event. Tickets to a ball
game or movie passes were also cited as
desirable incentives.
Strategy #6:
Enlist Community
Spokespeople, Survivors, and
Family Members to Lend
Influence
“If you are able to find a person that’s well
known or that has suffered with the disease or a national person that is willing to
discuss their personal history with the
entire nation then that would be one
powerful way of getting the word out…”
In every forum, participants repeatedly
and passionately identified AfricanAmerican men and their families who
have survived prostate cancer as critical
in motivating men to receive information
and make informed decisions. Fear of the
possibility of having cancer, especially
prostate cancer, was identified as one
barrier preventing African-American
men from making informed decisions
about their health. Participants noted that
survivors represent hope: even if you
have prostate cancer, it is possible to live
a long and healthy life. Survivors and
their families embody this notion.
Further, a well-known national spokesperson can increase the impact of an outreach effort, especially if the
spokesperson is an African-American
male. Participants cited national spokespeople in other disease areas as effective
in providing information. Former Presi-
Table 5. Themes and Incentives Recommended by Participants
Themes:
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•
Look good, feel good
Maintenance checks
Check it all in one stop
You can’t save me unless you save you
Don't wait until it is too late
Make sure you get your tune-up
Be healthy on the inside and look good on the outside
Incentives:
•
•
•
•
•
Home improvement gift certificates (Lowe’s, Home Depot, etc.)
Tickets to sporting events
Movie passes
Free car washes
Tool kits
VOICES OF EXPERIENCE — 4
dent Jimmy Carter and First Lady Nancy
Reagan as spokespeople for cancer
awareness, former professional football
player and coach Mike Ditka for treating
erectile dysfunction, and talk radio host
Tom Joyner and his “take your loved one
to the doctor” campaign were cited as
examples of national figures that have
aided various causes. A national African-American male spokesperson for
prostate cancer, especially if this person
was a survivor himself, would greatly
enhance the attention paid to prostate
cancer awareness among African-American men.
Participants also mentioned the vital importance of local influential leaders as effective in influencing men because of their
personal connection to many in the community. African-American ministers were
mentioned as being a relevant constituency
whose leadership would be valuable to
prostate cancer education and awareness.
As an example, participants noted when
one highly influential African-American
minister, Reverend Charles R. Williams,
revealed he had prostate cancer, participation in prostate cancer activities among
African-American men increased notably
at the Indiana Black Expo’s Health Fair.
All of the forum participants said AfricanAmerican women — spouses, girlfriends,
significant others, and mothers — are very
influential in motivating men to attend to
their health needs. Participants often
remarked that many men don’t consider
visits for preventive healthcare until they
have been told of its value by their wife or
mother, or have seen “prevention in action”
among women (i.e., mammograms, pap
tests, etc.).
Strategy #7:
Measure Success Over Time
“The best way to reach men is still one-onone communication, one man talking to
one man…it may not start off big, but it
will grow…”
“You’ve got to start small and build…people are going to be wary of you initially…but after you show them you have
good information and are in it for the
long-term, they will come…”
Programmatic success is often measured
by short-term participation, or the number
of people who attend one event. Participants in the forums frequently indicated
success must be measured over time. Participants also indicated one of the most
powerful methods of communication
within the African-American community
is word-of-mouth and one-on-one communication, specifically men talking to other
men. Programs able to attract a small group
of men will likely recruit growing numbers
of men over time.
Word-of-mouth communication can be a
double-edged sword, however, in that
either a positive or negative message may
be disseminated throughout the community. Participants were clear that even if initial outreach effort results are relatively
small, it is of critical importance for these
outreach efforts to be highly effective for
“positive” word-of-mouth to spread and
attract more men to the outreach effort over
time. Initial activities with unclear information or poorly managed sessions will
likely create either a lack of dialogue in the
community about the event, or negative
word-of-mouth communication, both detrimental to the long-term viability of any
outreach effort.
Now more than ever, public health organizations are held accountable by their
funders to demonstrate the results of their
outreach efforts. Because funders often
require annual reporting, the strategy of
“measuring success over time” may appear
less than practical. Assessing the success
of outreach efforts over time is possible,
but it requires more than simply counting
the number of individuals attending specific events or participating in various
screenings. Instead, public health professionals should tailor their evaluation
efforts to examine the extent to which participants have attended other related
events, communicated the relevant information to their friends and family, and/or
sought out other related resources (see
Table 6 for evaluation questions related to
the potential impact of an event over time).
In this way, the importance of specific
events can begin to be understood within
the larger context of the multidimensional
approaches described earlier in this report.
VOICES OF EXPERIENCE — 5
Table 6. Evaluation Questions
Related to Potential Impact Over
Time
• How did you find out about this
event?
• Have you attended other community events that have provided
information on prostate cancer?
• Are you likely to tell others about
this event? Who?
• As a result of attending this event
or similar events, have you talked
more about prostate cancer with
members of your family and/or
community?
• As a result of attending this event
or similar events, how likely are
you to encourage others to
attend similar events?
BRINGING IT ALL TOGETHER
In summary, public health professionals,
community members, educators, and faithbased leaders in the African-American
community throughout Indiana have identified seven main strategies for enhancing
public health outreach efforts to better
inform African-American men age 40-65
about prostate cancer. These strategies,
while described individually in this report,
should be applied simultaneously to outreach efforts. For example, although
themes and incentives can increase the
attractiveness of specific events (Strategy
#5), multidimensional approaches that
bring programming efforts to locations frequented by African-American men (Strategies #1 and #3) are going to yield greater
levels of success than intermittent, isolated
programs. Similarly, approaches should
employ messages to personalize the importance of preventive care (Strategy #2),
while at the same time providing complete
and concise information related specifically to prostate cancer (Strategy #4).
Applied together, these strategies can help
increase the impact of public health outreach efforts that disseminate information
on prostate cancer to African-American
men age 40-65.
Seven Strategies for Enhancing Prostate Cancer Outreach Efforts
1. Develop Relationships Through Multidimensional Approaches - effective information dissemination strategies must be
designed to be long-term, sustainable, relationship development oriented, and focused on cultivating supportive relationships
with stable community organizations.
2. Make it Personal…So it Becomes Relevant - because African-American men age 40-65 place a high value on taking care of
their family, messages related to “being there” for their family by taking care of their health are very powerful.
3. Go Where They Are - successful educational programs should be offered at places and locations in the community where
African-American men are, and should be offered at non-traditional locations in order to reach a larger cross-section of men.
4. Give Them the Truth, Make it Simple, and Don’t Overwhelm - effective outreach programs will provide men with complete
and concise information in a culturally competent manner.
5. Get Their Attention with Relevant Themes and Incentives - African-American men are more likely to attend educational and
outreach events when interesting themes and desirable incentives are involved.
6. Enlist Community Spokespeople, Survivors, and Family Members to Lend Influence - effective programs mobilize the influence of cancer survivors and their families, prominent national and local African-American men, and African-American
women to champion education outreach.
7. Measure Success Over Time - effective programs must be highly useful initially, must plan for the number of men reached to
grow over time, and must measure success not at one initial event, but rather as growth over time.
To learn more about the ISDH Prostate Cancer Initiative, contact William Thornton at 317-234-2883
or email [email protected]
2 North Meridian Street
Indianapolis, IN 46204
Seven Outreach Strategies for Disseminating
Prostate Cancer Information to African American Men
Voices of Experience is published by the Center for Evaluation and Education Policy
More about the Center for Evaluation & Education Policy
and our publications can be found at our web site:
http://ceep.indiana.edu